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Emergency Influenza-Like Illness Spikes In Minnesota
Recombinomics Commentary 15:00
September 30, 2011

The graph below represents weekly levels of influenza-like illness (ILI) among emergency department visits in Minnesota and depicts a sharp increase in the past two weeks, to levels comparable to those reported during the peak of the flu season in early 2011. 

Minnesota Emergency ILI
This sharp increase in ILI levels is also supported by increases in influenza in a number of US cites as measured by Google flu trends for Minneapolis, MN; Philadelphia, PA; Miami, FL; Atlanta, GA; Chicago, IL; Dallas and Austin, TX as well as the spike in the Pneumonia and Influenza (P&I) death rate for week 38..  These recent increases are in sharp contrast to the number of lab confirmed flu cases as reported in the CDC’s fluview, which included 3 cases for the entire country in week 37.

The week 37 report also removed previously reported unsubtypables for week 33 and week 34, which corresponded to collections dates for trH3N2 cases in Pennsylvania, raising concern that the routine influenza A or H3 assays on trH3N2 cases evaluated by the CDC are being reported as negative, leading to the low levels being reported including the absence of newly discovered trH3N2.

The recent trH3N2 cases in Pennsylvania and Indiana were virtually identical to each other, and the H3 sequence was an evolved version of trH3N2 2010 isolates from Pennsylvania, Minnesota, and Wisconsin.  The clustering of these sequences in human trH3N2 isolates supports human to human transmission, a does the failure to identify a swine source for the 2011 cases, including the clustering of three confirmed cases at the Washington County fair in Pennsylvania, as well as the Indiana case who did not have contact with swine.

The recent results raise serious questions about the CDC testing of trH3N2 cases, including the removal of the previously reported 2011 unsubtypables, and the unreported unsubtypables reported by Pennsylvania in late 2010 and early 2011.

A detail explanation of these prior CDC results and modifications is long overdue.

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